|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$81.23
|
|
|
Service Code
|
NDC 65162089703
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.06 |
| Max. Negotiated Rate |
$73.11 |
| Rate for Payer: Aetna American Axle |
$52.80
|
| Rate for Payer: Aetna Commercial |
$69.05
|
| Rate for Payer: Aetna Medicare |
$40.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.80
|
| Rate for Payer: BCBS Complete |
$32.49
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cofinity Commercial |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$69.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.98
|
| Rate for Payer: Healthscope Commercial |
$73.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.05
|
| Rate for Payer: PHP Commercial |
$69.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.80
|
| Rate for Payer: Priority Health SBD |
$51.17
|
| Rate for Payer: UMR Bronson Commercial |
$30.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.92
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
OP
|
$1,831.87
|
|
|
Service Code
|
NDC 00904651061
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$677.79 |
| Max. Negotiated Rate |
$1,648.68 |
| Rate for Payer: Aetna American Axle |
$1,190.72
|
| Rate for Payer: Aetna Commercial |
$1,557.09
|
| Rate for Payer: Aetna Medicare |
$915.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.72
|
| Rate for Payer: BCBS Complete |
$732.75
|
| Rate for Payer: Cash Price |
$1,465.50
|
| Rate for Payer: Cofinity Commercial |
$1,282.31
|
| Rate for Payer: Cofinity Commercial |
$1,575.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,282.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.50
|
| Rate for Payer: Healthscope Commercial |
$1,648.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,282.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,373.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,557.09
|
| Rate for Payer: PHP Commercial |
$1,557.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.72
|
| Rate for Payer: Priority Health SBD |
$1,154.08
|
| Rate for Payer: UMR Bronson Commercial |
$677.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.90
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
|
IP
|
$199.16
|
|
|
Service Code
|
NDC 60505267303
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$179.24 |
| Rate for Payer: Aetna American Axle |
$129.45
|
| Rate for Payer: Aetna Commercial |
$169.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.45
|
| Rate for Payer: Cash Price |
$159.33
|
| Rate for Payer: Cofinity Commercial |
$139.41
|
| Rate for Payer: Cofinity Commercial |
$171.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.33
|
| Rate for Payer: Healthscope Commercial |
$179.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.29
|
| Rate for Payer: PHP Commercial |
$169.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.45
|
| Rate for Payer: Priority Health SBD |
$125.47
|
| Rate for Payer: UMR Bronson Commercial |
$87.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.37
|
|
|
ARIPIPRAZOLE ER 300 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$5,834.47
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
165265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$5,251.02 |
| Rate for Payer: Aetna American Axle |
$3,792.41
|
| Rate for Payer: Aetna Commercial |
$4,959.30
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,792.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.10
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: BCBS MAPPO |
$7.28
|
| Rate for Payer: BCN Medicare Advantage |
$7.28
|
| Rate for Payer: Cash Price |
$4,667.58
|
| Rate for Payer: Cash Price |
$4,667.58
|
| Rate for Payer: Cofinity Commercial |
$5,017.64
|
| Rate for Payer: Cofinity Commercial |
$4,084.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,084.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,667.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$5,251.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,084.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,375.85
|
| Rate for Payer: Mclaren Medicaid |
$3.90
|
| Rate for Payer: Mclaren Medicare |
$7.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.64
|
| Rate for Payer: Meridian Medicaid |
$4.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,959.30
|
| Rate for Payer: PACE Medicare |
$6.92
|
| Rate for Payer: PACE SWMI |
$7.28
|
| Rate for Payer: PHP Commercial |
$4,959.30
|
| Rate for Payer: PHP Medicare Advantage |
$7.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,792.41
|
| Rate for Payer: Priority Health Medicare |
$7.28
|
| Rate for Payer: Priority Health SBD |
$3,675.72
|
| Rate for Payer: Railroad Medicare Medicare |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.28
|
| Rate for Payer: UHC Exchange |
$13.91
|
| Rate for Payer: UHC Medicare Advantage |
$7.28
|
| Rate for Payer: UHCCP Medicaid |
$3.90
|
| Rate for Payer: UMR Bronson Commercial |
$2,158.75
|
| Rate for Payer: VA VA |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,375.85
|
|
|
ARIPIPRAZOLE ER 300 MG INTRAMUSCULAR SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$5,834.47
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
165265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,567.17 |
| Max. Negotiated Rate |
$5,251.02 |
| Rate for Payer: Aetna American Axle |
$3,792.41
|
| Rate for Payer: Aetna Commercial |
$4,959.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,792.41
|
| Rate for Payer: Cash Price |
$4,667.58
|
| Rate for Payer: Cofinity Commercial |
$4,084.13
|
| Rate for Payer: Cofinity Commercial |
$5,017.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,084.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,667.58
|
| Rate for Payer: Healthscope Commercial |
$5,251.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,084.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,375.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,959.30
|
| Rate for Payer: PHP Commercial |
$4,959.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,792.41
|
| Rate for Payer: Priority Health SBD |
$3,675.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,567.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,375.85
|
|
|
ARIPIPRAZOLE ER 300 MG SUSPENSION, EXTENDED REL. INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$5,834.47
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$5,251.02 |
| Rate for Payer: Aetna American Axle |
$3,792.41
|
| Rate for Payer: Aetna Commercial |
$4,959.30
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,792.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.10
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: BCBS MAPPO |
$7.28
|
| Rate for Payer: BCN Medicare Advantage |
$7.28
|
| Rate for Payer: Cash Price |
$4,667.58
|
| Rate for Payer: Cash Price |
$4,667.58
|
| Rate for Payer: Cofinity Commercial |
$5,017.64
|
| Rate for Payer: Cofinity Commercial |
$4,084.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,084.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,667.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$5,251.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,084.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,375.85
|
| Rate for Payer: Mclaren Medicaid |
$3.90
|
| Rate for Payer: Mclaren Medicare |
$7.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.64
|
| Rate for Payer: Meridian Medicaid |
$4.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,959.30
|
| Rate for Payer: PACE Medicare |
$6.92
|
| Rate for Payer: PACE SWMI |
$7.28
|
| Rate for Payer: PHP Commercial |
$4,959.30
|
| Rate for Payer: PHP Medicare Advantage |
$7.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,792.41
|
| Rate for Payer: Priority Health Medicare |
$7.28
|
| Rate for Payer: Priority Health SBD |
$3,675.72
|
| Rate for Payer: Railroad Medicare Medicare |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.28
|
| Rate for Payer: UHC Exchange |
$13.91
|
| Rate for Payer: UHC Medicare Advantage |
$7.28
|
| Rate for Payer: UHCCP Medicaid |
$3.90
|
| Rate for Payer: UMR Bronson Commercial |
$2,158.75
|
| Rate for Payer: VA VA |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,375.85
|
|
|
ARIPIPRAZOLE ER 300 MG SUSPENSION, EXTENDED REL. INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$5,834.47
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,567.17 |
| Max. Negotiated Rate |
$5,251.02 |
| Rate for Payer: Aetna American Axle |
$3,792.41
|
| Rate for Payer: Aetna Commercial |
$4,959.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,792.41
|
| Rate for Payer: Cash Price |
$4,667.58
|
| Rate for Payer: Cofinity Commercial |
$4,084.13
|
| Rate for Payer: Cofinity Commercial |
$5,017.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,084.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,667.58
|
| Rate for Payer: Healthscope Commercial |
$5,251.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,084.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,375.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,959.30
|
| Rate for Payer: PHP Commercial |
$4,959.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,792.41
|
| Rate for Payer: Priority Health SBD |
$3,675.72
|
| Rate for Payer: UMR Bronson Commercial |
$2,567.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,375.85
|
|
|
ARIPIPRAZOLE ER 400 MG SUSPENSION, EXTENDED REL.INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$6,320.66
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,781.09 |
| Max. Negotiated Rate |
$5,688.59 |
| Rate for Payer: Aetna American Axle |
$4,108.43
|
| Rate for Payer: Aetna Commercial |
$5,372.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,108.43
|
| Rate for Payer: Cash Price |
$5,056.53
|
| Rate for Payer: Cofinity Commercial |
$4,424.46
|
| Rate for Payer: Cofinity Commercial |
$5,435.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,424.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,056.53
|
| Rate for Payer: Healthscope Commercial |
$5,688.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,424.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,740.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,372.56
|
| Rate for Payer: PHP Commercial |
$5,372.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,108.43
|
| Rate for Payer: Priority Health SBD |
$3,982.02
|
| Rate for Payer: UMR Bronson Commercial |
$2,781.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,740.49
|
|
|
ARIPIPRAZOLE ER 400 MG SUSPENSION, EXTENDED REL.INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$6,320.66
|
|
|
Service Code
|
HCPCS J0401
|
| Hospital Charge Code |
173712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$5,688.59 |
| Rate for Payer: Aetna American Axle |
$4,108.43
|
| Rate for Payer: Aetna Commercial |
$5,372.56
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,108.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.10
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: BCBS MAPPO |
$7.28
|
| Rate for Payer: BCN Medicare Advantage |
$7.28
|
| Rate for Payer: Cash Price |
$5,056.53
|
| Rate for Payer: Cash Price |
$5,056.53
|
| Rate for Payer: Cofinity Commercial |
$5,435.77
|
| Rate for Payer: Cofinity Commercial |
$4,424.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,424.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,056.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$5,688.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,424.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,740.49
|
| Rate for Payer: Mclaren Medicaid |
$3.90
|
| Rate for Payer: Mclaren Medicare |
$7.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.64
|
| Rate for Payer: Meridian Medicaid |
$4.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,372.56
|
| Rate for Payer: PACE Medicare |
$6.92
|
| Rate for Payer: PACE SWMI |
$7.28
|
| Rate for Payer: PHP Commercial |
$5,372.56
|
| Rate for Payer: PHP Medicare Advantage |
$7.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,108.43
|
| Rate for Payer: Priority Health Medicare |
$7.28
|
| Rate for Payer: Priority Health SBD |
$3,982.02
|
| Rate for Payer: Railroad Medicare Medicare |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.28
|
| Rate for Payer: UHC Exchange |
$13.91
|
| Rate for Payer: UHC Medicare Advantage |
$7.28
|
| Rate for Payer: UHCCP Medicaid |
$3.90
|
| Rate for Payer: UMR Bronson Commercial |
$2,338.64
|
| Rate for Payer: VA VA |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,740.49
|
|
|
ARMODAFINIL 150 MG TABLET
|
Facility
|
OP
|
$3,763.13
|
|
|
Service Code
|
NDC 63459021530
|
| Hospital Charge Code |
96966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,392.36 |
| Max. Negotiated Rate |
$3,386.82 |
| Rate for Payer: Aetna American Axle |
$2,446.03
|
| Rate for Payer: Aetna Commercial |
$3,198.66
|
| Rate for Payer: Aetna Medicare |
$1,881.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.03
|
| Rate for Payer: BCBS Complete |
$1,505.25
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Cofinity Commercial |
$2,634.19
|
| Rate for Payer: Cofinity Commercial |
$3,236.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,634.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,010.50
|
| Rate for Payer: Healthscope Commercial |
$3,386.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,634.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,822.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,198.66
|
| Rate for Payer: PHP Commercial |
$3,198.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,446.03
|
| Rate for Payer: Priority Health SBD |
$2,370.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,392.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,822.35
|
|
|
ARMODAFINIL 150 MG TABLET
|
Facility
|
IP
|
$3,763.13
|
|
|
Service Code
|
NDC 63459021530
|
| Hospital Charge Code |
96966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,655.78 |
| Max. Negotiated Rate |
$3,386.82 |
| Rate for Payer: Aetna American Axle |
$2,446.03
|
| Rate for Payer: Aetna Commercial |
$3,198.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.03
|
| Rate for Payer: Cash Price |
$3,010.50
|
| Rate for Payer: Cofinity Commercial |
$2,634.19
|
| Rate for Payer: Cofinity Commercial |
$3,236.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,634.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,010.50
|
| Rate for Payer: Healthscope Commercial |
$3,386.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,634.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,822.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,198.66
|
| Rate for Payer: PHP Commercial |
$3,198.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,446.03
|
| Rate for Payer: Priority Health SBD |
$2,370.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,655.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,822.35
|
|
|
ARMODAFINIL 50 MG TABLET
|
Facility
|
OP
|
$115.71
|
|
|
Service Code
|
NDC 69339017703
|
| Hospital Charge Code |
96965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$104.14 |
| Rate for Payer: Aetna American Axle |
$75.21
|
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: Aetna Medicare |
$57.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.21
|
| Rate for Payer: BCBS Complete |
$46.28
|
| Rate for Payer: Cash Price |
$92.57
|
| Rate for Payer: Cofinity Commercial |
$81.00
|
| Rate for Payer: Cofinity Commercial |
$99.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.57
|
| Rate for Payer: Healthscope Commercial |
$104.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.35
|
| Rate for Payer: PHP Commercial |
$98.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.21
|
| Rate for Payer: Priority Health SBD |
$72.90
|
| Rate for Payer: UMR Bronson Commercial |
$42.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.78
|
|
|
ARMODAFINIL 50 MG TABLET
|
Facility
|
IP
|
$115.71
|
|
|
Service Code
|
NDC 69339017703
|
| Hospital Charge Code |
96965
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$104.14 |
| Rate for Payer: Aetna American Axle |
$75.21
|
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.21
|
| Rate for Payer: Cash Price |
$92.57
|
| Rate for Payer: Cofinity Commercial |
$81.00
|
| Rate for Payer: Cofinity Commercial |
$99.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.57
|
| Rate for Payer: Healthscope Commercial |
$104.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.35
|
| Rate for Payer: PHP Commercial |
$98.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.21
|
| Rate for Payer: Priority Health SBD |
$72.90
|
| Rate for Payer: UMR Bronson Commercial |
$50.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.78
|
|
|
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); COMBINED DISTAL FEMUR, PROXIMAL TIBIA AND FIBULA
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27479
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); DISTAL FEMUR
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); TIBIA AND FIBULA, PROXIMAL
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27477
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL FIBULA
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 27732
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), OPEN; DISTAL TIBIA AND FIBULA
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 27734
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
ARREST, HEMIEPIPHYSEAL, DISTAL FEMUR OR PROXIMAL TIBIA OR FIBULA (EG, GENU VARUS OR VALGUS)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27485
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$179.60
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
29071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.02 |
| Max. Negotiated Rate |
$161.64 |
| Rate for Payer: Aetna American Axle |
$116.74
|
| Rate for Payer: Aetna Commercial |
$152.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.74
|
| Rate for Payer: Cash Price |
$143.68
|
| Rate for Payer: Cofinity Commercial |
$125.72
|
| Rate for Payer: Cofinity Commercial |
$154.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.68
|
| Rate for Payer: Healthscope Commercial |
$161.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.66
|
| Rate for Payer: PHP Commercial |
$152.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.74
|
| Rate for Payer: Priority Health SBD |
$113.15
|
| Rate for Payer: UMR Bronson Commercial |
$79.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.70
|
|
|
ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$147.43
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
29071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$132.69 |
| Rate for Payer: Aetna American Axle |
$95.83
|
| Rate for Payer: Aetna American Axle |
$116.74
|
| Rate for Payer: Aetna American Axle |
$132.13
|
| Rate for Payer: Aetna Commercial |
$172.79
|
| Rate for Payer: Aetna Commercial |
$125.32
|
| Rate for Payer: Aetna Commercial |
$152.66
|
| Rate for Payer: Aetna Medicare |
$8.48
|
| Rate for Payer: Aetna Medicare |
$8.48
|
| Rate for Payer: Aetna Medicare |
$8.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.19
|
| Rate for Payer: BCBS Complete |
$4.59
|
| Rate for Payer: BCBS Complete |
$4.59
|
| Rate for Payer: BCBS Complete |
$4.59
|
| Rate for Payer: BCBS MAPPO |
$8.15
|
| Rate for Payer: BCBS MAPPO |
$8.15
|
| Rate for Payer: BCBS MAPPO |
$8.15
|
| Rate for Payer: BCN Medicare Advantage |
$8.15
|
| Rate for Payer: BCN Medicare Advantage |
$8.15
|
| Rate for Payer: BCN Medicare Advantage |
$8.15
|
| Rate for Payer: Cash Price |
$143.68
|
| Rate for Payer: Cash Price |
$117.94
|
| Rate for Payer: Cash Price |
$117.94
|
| Rate for Payer: Cash Price |
$162.62
|
| Rate for Payer: Cash Price |
$162.62
|
| Rate for Payer: Cash Price |
$143.68
|
| Rate for Payer: Cofinity Commercial |
$125.72
|
| Rate for Payer: Cofinity Commercial |
$174.82
|
| Rate for Payer: Cofinity Commercial |
$142.30
|
| Rate for Payer: Cofinity Commercial |
$154.46
|
| Rate for Payer: Cofinity Commercial |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$126.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.15
|
| Rate for Payer: Healthscope Commercial |
$182.95
|
| Rate for Payer: Healthscope Commercial |
$132.69
|
| Rate for Payer: Healthscope Commercial |
$161.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.46
|
| Rate for Payer: Mclaren Medicaid |
$4.37
|
| Rate for Payer: Mclaren Medicaid |
$4.37
|
| Rate for Payer: Mclaren Medicaid |
$4.37
|
| Rate for Payer: Mclaren Medicare |
$8.15
|
| Rate for Payer: Mclaren Medicare |
$8.15
|
| Rate for Payer: Mclaren Medicare |
$8.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.56
|
| Rate for Payer: Meridian Medicaid |
$4.59
|
| Rate for Payer: Meridian Medicaid |
$4.59
|
| Rate for Payer: Meridian Medicaid |
$4.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.32
|
| Rate for Payer: PACE Medicare |
$7.74
|
| Rate for Payer: PACE Medicare |
$7.74
|
| Rate for Payer: PACE Medicare |
$7.74
|
| Rate for Payer: PACE SWMI |
$8.15
|
| Rate for Payer: PACE SWMI |
$8.15
|
| Rate for Payer: PACE SWMI |
$8.15
|
| Rate for Payer: PHP Commercial |
$152.66
|
| Rate for Payer: PHP Commercial |
$125.32
|
| Rate for Payer: PHP Commercial |
$172.79
|
| Rate for Payer: PHP Medicare Advantage |
$8.15
|
| Rate for Payer: PHP Medicare Advantage |
$8.15
|
| Rate for Payer: PHP Medicare Advantage |
$8.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.13
|
| Rate for Payer: Priority Health Medicare |
$8.15
|
| Rate for Payer: Priority Health Medicare |
$8.15
|
| Rate for Payer: Priority Health Medicare |
$8.15
|
| Rate for Payer: Priority Health SBD |
$113.15
|
| Rate for Payer: Priority Health SBD |
$128.07
|
| Rate for Payer: Priority Health SBD |
$92.88
|
| Rate for Payer: Railroad Medicare Medicare |
$8.15
|
| Rate for Payer: Railroad Medicare Medicare |
$8.15
|
| Rate for Payer: Railroad Medicare Medicare |
$8.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.15
|
| Rate for Payer: UHC Exchange |
$15.58
|
| Rate for Payer: UHC Exchange |
$15.58
|
| Rate for Payer: UHC Exchange |
$15.58
|
| Rate for Payer: UHC Medicare Advantage |
$8.15
|
| Rate for Payer: UHC Medicare Advantage |
$8.15
|
| Rate for Payer: UHC Medicare Advantage |
$8.15
|
| Rate for Payer: UHCCP Medicaid |
$4.37
|
| Rate for Payer: UHCCP Medicaid |
$4.37
|
| Rate for Payer: UHCCP Medicaid |
$4.37
|
| Rate for Payer: UMR Bronson Commercial |
$54.55
|
| Rate for Payer: UMR Bronson Commercial |
$75.21
|
| Rate for Payer: UMR Bronson Commercial |
$66.45
|
| Rate for Payer: VA VA |
$8.15
|
| Rate for Payer: VA VA |
$8.15
|
| Rate for Payer: VA VA |
$8.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.46
|
|
|
ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET
|
Facility
|
OP
|
$463.81
|
|
|
Service Code
|
NDC 00078056845
|
| Hospital Charge Code |
96948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.61 |
| Max. Negotiated Rate |
$417.43 |
| Rate for Payer: Aetna American Axle |
$301.48
|
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: Aetna Medicare |
$231.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.48
|
| Rate for Payer: BCBS Complete |
$185.52
|
| Rate for Payer: Cash Price |
$371.05
|
| Rate for Payer: Cofinity Commercial |
$324.67
|
| Rate for Payer: Cofinity Commercial |
$398.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.05
|
| Rate for Payer: Healthscope Commercial |
$417.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.24
|
| Rate for Payer: PHP Commercial |
$394.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.48
|
| Rate for Payer: Priority Health SBD |
$292.20
|
| Rate for Payer: UMR Bronson Commercial |
$171.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.86
|
|
|
ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET
|
Facility
|
IP
|
$463.81
|
|
|
Service Code
|
NDC 00078056845
|
| Hospital Charge Code |
96948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.08 |
| Max. Negotiated Rate |
$417.43 |
| Rate for Payer: Aetna American Axle |
$301.48
|
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.48
|
| Rate for Payer: Cash Price |
$371.05
|
| Rate for Payer: Cofinity Commercial |
$324.67
|
| Rate for Payer: Cofinity Commercial |
$398.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.05
|
| Rate for Payer: Healthscope Commercial |
$417.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.24
|
| Rate for Payer: PHP Commercial |
$394.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.48
|
| Rate for Payer: Priority Health SBD |
$292.20
|
| Rate for Payer: UMR Bronson Commercial |
$204.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.86
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 36819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 36818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
